The objective of this project is to evaluate the impact of a newly developed team approach to home care for patients in Monroe County with chronic or terminal illness who wish to receive care at home rather than in an institution. Using a randomized controlled trial design, the described high quality home care team approach will be compared with conventional care in terms of impact upon health care utilization patterns and cost of care, quality of life measures, and satisfaction with care. The expected outcome will be 1) reduced cost for care through a reduction in emergency room evaluations and hastily arranged for, often inappropriate acute care hospital admissions, 2) better psycho-social functioning at home with good support services, 3) more satisfaction with care at this critical phase of life, 4) longer or equal survival time as compared to receiving conventional care at home or in an institution. This study should provide useful insights as to probable future dimensions of health care delivery mechanisms, including financial aspects.